Dukoral Cholera Vaccine Dosing for Ages 2 Years and Older
For individuals aged 2 years and older, Dukoral is administered as two oral doses given 1-6 weeks apart, with each dose consisting of killed whole-cell Vibrio cholerae O1 with purified recombinant B subunit of cholera toxin. 1
Standard Dosing Schedule
- Two doses are required for the primary vaccination series, administered orally at an interval of 1-6 weeks apart 1
- Each dose contains killed whole-cell Vibrio cholerae O1 bacteria plus the recombinant B subunit of cholera toxin (WC-rBS formulation) 1, 2
- The vaccine is most commonly administered to travelers planning to visit cholera-endemic areas 1
Vaccine Efficacy by Dosing Regimen
- Two doses of Dukoral provide 76% protection (RR 0.24,95% CI 0.08 to 0.65) against cholera at two-year follow-up in general populations of children and adults 3
- The vaccine demonstrates 85% efficacy at 6 months after the two-dose series 1
- Protection duration varies considerably between individuals, lasting up to 3 years in some vaccinees, though efficacy typically wanes after 2 years 1
Age-Specific Considerations
- While Dukoral is licensed for use in individuals aged 2 years and older in approximately 20 countries, the vaccine is notably less effective in young children 1
- In field trials conducted in Peru, Dukoral offered negative protection in children under 5 years of age during the first year of surveillance 4
- Children aged 2 to <5 years mount primarily IgM antibody responses to the O-specific polysaccharide antigen with minimal IgA and IgG responses, unlike older children and adults who produce class-switched antibodies 5
- Young children also fail to develop memory B-cell responses to the O-specific polysaccharide component, which may explain the rapid waning of protection in this age group 5
Important Limitations and Caveats
- The United States does not advocate Dukoral use, even for travelers, and the vaccine is not available in the U.S. 1
- The vaccine formulation uses V. cholerae O1 strains isolated in 1947 that have been inactivated by heat and formalin, which may denature protective proteins 4
- Dukoral provides no protection against Vibrio cholerae O139 serogroup, limiting its utility in areas where this serogroup circulates 4
- The requirement for a cold supply chain, multiple doses, and complex logistics reduce the vaccine's suitability for epidemic cholera control in resource-poor settings 4
Alternative Vaccine Options
- For travelers from the United States, CVD 103-HgR (previously Vaxchora) is the only FDA-approved cholera vaccine, administered as a single oral dose for adults aged 18-64 years 1
- Bivalent whole-cell vaccines (Shanchol, Euvichol/Euvichol-Plus) offer superior protection in young children and cover both O1 and O139 serogroups, though these are not available in all countries 3
Practical Administration Points
- The vaccine should be administered with buffer solution as originally formulated, though research suggests administration in water does not significantly reduce vibriocidal responses 6
- Temporarily withholding breastfeeding for 3 hours before immunization in infants and young children can enhance immune responses, increasing vibriocidal antibody responders from 57% to 77% 6
- Zinc supplementation (20 mg daily for 42 days) similarly enhances responses, achieving 79% responders 6